Sensory Problem Set

Problem 1
Last Thursday at midnight, Mr. X (your patient) came out of a bar and was attacked in a
dark alley. He suffered a hemisection of the right side of the spinal cord at a high lumbar
spinal level. Upon examination, you discovered that Mr. X lacks vibration and two-point
discriminative sensation in the right lower extremity as well as thermal, pain and
mechanical sensations in the left lower extremity.

Symptoms: Loss of position sense (posture), Affected Pathway:

vibration and highly discriminative touch on ____________________
the lower right extremity.

Symptoms: Loss of crude mechanosensory, Affected Pathway:

analgesia, thermanesthesia on the lower left _____________________
extremity.

R L
Problem 1

R L

R L
Problem 1

_____________________

_____________________

Dorsal column path Anterolateral path

R L R L

RNu RNu

R L

Fasc. gracilis
ALF

Mech. Dorsal horn Pain & temp.

sensations lower limb
lower limb Anterior (ventral)
white commissure
Problem 1

Location: ___________________________
Information:
_____________________________________________________________
___________________________________________________

Location: _____________________________
Information:
______________________________________________________________
____________________________________________________

R L
Problem 1

Dorsal column-lemniscal path

a) The lesion of the dorsal columns would result in degenerating
axon terminals in what nucleus (or nuclei) in the brainstem? R L
__________________________
Is the nucleus ipsilateral or contralateral to the lesion? ____________
Draw the dorsal columns pathway until you reach the nucleus
of termination in the brainstem

b) Name the second-order neurons in the dorsal column pathway

and draw them in the diagram. RNu

_________________________________________________

Is the projection crossed? __________________

Fasc. Nucleus
gracilis gracilis

Internal
Arcuate
fibers
Medial
lemniscus
Problem 1

Dorsal column-lemniscal path

Where do the axons of the affected pathway terminate?

R L
_____________________________________________
Is it possible that the neurons of this tract would degenerate slowly
after the lesion?

_______________________________________________

_______________________________________________
RNu

Medial
lemniscus

Nucleus
gracilis
Fasc.
gracilis

Mech. sensations
lower limb
Problem 1

Anterolateral spino-thalamic path

R L
The lesion of the ALF would result in degenerating axons
terminals in what thalamic nucleus? Target?
_____________________
__________________________________________

RNu

Would there be degeneration of axon terminals on route to the

thalamus? Which tract?

___________________________________________________

___________________________________________________

Draw the ALF pathway until you reach the nucleus termination.
Is the nucleus ipsilateral or contralateral to the lesion? ___________
Problem 1
a) The dorsal column lesion would interrupt information
going to the ________ cerebral hemisphere.
Most specifically, the ____________ region of the
___________ gyrus.
b) The ALF lesion would interrupt information
going to the ________ hemisphere in the
_____________ region of the ___________
gyrus.
Problem 1

_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
___

R L

R L
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Problem 2

L R
L R

Lower
open medulla

L R
Open medulla
Problem 2

_________________

Putative site of lesion

L R

______________________________________________________

______________________________________________________
Problem 2

________

___________________________

L R

L R

________________________________

Open medulla
Problem 2

_______________________

_______________________ L R

L R

_________________
_________________
Problem 2

______________________________________________________________________
?

L R

_______________________________________________________________
_______________________________________________________________

_____________________________________________________________
_____________________________________________________________
__
Problem 2

R L

RNu

________________________________________________________________________
________________________________________________________________________
__
Problem 3
Problem 3

_________________________________________

_______________________________

R L R L

Anterolateral fasciculi
Problem 3

_____________________________________________________

__________________________________________________________________________
__________________________________________________________________________

T2
T7

T10 and below

R
L
R
L
R Affected ALF
L AWC Spared ALF
Problem 3

Cervical spinal
cord:_________________________________
_________________________

Thalamus:____________________________
_____________________________________
_

Cerebral cortex:
______________________________________
________________________
Problem 3

___________________________________________________________________________

________________________________________________

_____________________________________________________________________________
_____________________________________________________________________________
__